What is Diabetes Mellitus

There are several different types of Diabetes:

Type 1 Diabetes Mellitus is a chronic condition that normally begins during adolescence where the pancreas is unable to produce enough insulin to control blood glucose levels.  This can be caused by genetic factors or in some cases by certain viruses. Whist some people may see regression of type 1 diabetes at some stage during adulthood, most will require lifelong treatment with insulin injections.

Type 2 Diabetes Mellitus (T2DM) is the most common form of diabetes associated with cardiometabolic disease. T2DM is a slow progressive disease that will often begin as a result of diet and lifestyle factors that contribute to a consistently elevated blood glucose level, obesity, in particular central abdominal adiposity, and a systemic chronic inflammatory state that leads to endocrine disruption.  

T2DM often begins with a pre-diabetic state where the body still has some capacity to control blood glucose levels, although the levels remain consistently mildly elevated.  Early intervention and management of the pre-diabetic state through modifiable lifestyle factors and approaches to correcting dysregulation of the endocrine metabolic state can often see reversal of the pre-diabetic states and avoidance of developing T2DM.  If the condition continues, insulin resistance develops, eventually resulting in the reduction of insulin production by the pancreas, and T2DM develops.  

Gestational Diabetes is a condition whereby womens blood glucose regulation is interrupted during pregnancy.  Standard antenatal care screens pregnant women for this condition, and it is usually managed through diet and medication for the duration of the pregnancy.  Following the birth of the baby gestational diabetes will usually resolve.

A rare condition known as Diabetes Insipidus is not related to Diabetes Mellitus and is instead a disorder that affects the fluid balance of the body resulting in very high urine output.

The conventional approach

The conventional approach to management of Type 2 Diabetes Mellitus (T2DM) involves:

Dietary modification to reduce simple sugar intake and increase complex carbohydrates, quality proteins and fibre.

Increase physical activity to assist with glucose utilisation and achieve and maintain a healthy weight.

Reduce overweight and obesity through diet and exercise.

If these non-pharmacological approaches are not effective in managing blood glucose levels, then the next stage of treatment will usually involve prescribing oral hypoglycaemics.

These are prescription medications that act to reduce blood glucose levels.  In some cases when blood glucose levels are already elevated, these medications may be used while the diet and lifestyle strategies are implemented.

In some cases, diet and lifestyle modification and oral hypoglycaemics will not be effective in reducing blood sugar levels, and in these situations a person may be prescribed insulin injections.  Insulin is the hormone in the body that is responsible for opening the pathway to allow glucose to move out of the blood and into the cells where it is used to produce energy.  Often during the development of T2DM a person will develop a metabolic condition called insulin resistance where normal insulin production by the body is ineffective in controlling blood sugar levels.

Whilst in some people these strategies may be effective in managing blood glucose levels, this approach to the management of T2DM does not address the primary underlying cause for the development of insulin resistance and dysregulated blood glucose, inflammation.

If the systemic inflammatory state of the body which is causing the metabolic disruption continues it is unlikely that these conventional approaches to treatment of T2DM will be effective long term.

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After
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Signs and symptoms

The most common signs and symptoms of Type 2 Diabetes Mellitus are:

Elevated blood glucose levels higher than 6.8mmol/L when fasting.

Increased thirst that is not satisfied by drinking water

Increased urination, particularly at night, and often associated with glucose in the urine when tested.

Increased hunger as the body is unable to make use of the glucose in the blood for energy.

If the condition remains undetected and continues long term the elevated blood glucose levels may result in:

Blurred vision (Diabetic retinopathy)

Drowsiness and general lethargy

Decreased exercise tolerance

Damage to the nervous system (Diabetic neuropathy)

Damage to the kidneys (Diabetic nephropathy)

Damage to the heart and blood vessels leading to what is called cardiometabolic disease.

Root causes

There is a growing body of evidence that modifiable lifestyle factors including diet, physical activity, stress management, weight management and smoking cessation are the most important factors for preventing type 2 diabetes Mellitus and cardiometabolic disease..  When these factors are not addressed as part of a healthy lifestyle, the body becomes systemically inflamed, and this inflammatory state becomes the primary driver for the development and progression of Type 2 Diabetes Mellitusand is one of the key factors in the development of cardiometabolic disease.

The functional medicine approach is to also look closely for other potential drivers of inflammation in the body such as food allergies or intolerances, toxicity, stressors, hormonal irregularities or autoimmune disorders, and to address these dysfunctions so the body has the capacity to heal.

Rippe, JM. (2019) Lifestyle strategies for risk factor reduction, prevention, and treatment of cardiovascular disease, American Journal of Lifestyle Medicine, 13(2), doi https://dx.doi.org/10.1177%2F1559827618812395

What causes eczema?

There isn’t one single cause of eczema but a range of potential contributing factors that are unique to each person. These include:

Genetics

Research has found people with the ‘atopic triad’ have a defective barrier of the skin and upper and lower respiratory tracts.

These genetic alterations cause a loss of function of filaggrin (filament aggregating protein), which is a protein in the skin that normally breaks down to create natural moisturisation and protect the skin from penetration by pathogens and allergens.

Filaggrin mutations are found in approximately 30 percent of people with atopic dermatitis, and also predispose people to asthma, allergic rhinitis (hayfever), keratosis pilaris (dry rough patches and bumps on the skin), and ichthyosis vulgaris (a chronic condition which causes thick, dry, scaly skin.)If one parent carries this genetic alteration, there is a 50 percent chance their child will develop atopic symptoms. And that risk increases to 80 percent if both parents are affected. 

Food allergy and sensitivity

Food hypersensitivity has been found to cause or exacerbate atopic dermatitis in 10-30% of cases, and 90% of these are caused by eggs, milk, peanuts, soy and wheat.

Compromised gut health

The connection between the gut microbiome and skin health is complex, however, research has found the microbiota contributes to the development, persistence, and severity of atopic dermatitis through immunologic, metabolic and neuroendocrine pathways.

Nutritional deficiencies

Deficiency of Omega-6 essential fatty acids (EFA) has been linked with the increased incidence of atopic dermatitis, along with the inability for the body to efficiently metabolise EFA’s to gamma linoleic acids (GLA) and arachidonic acids (AA).

Weather and environment

Changing weather conditions can certainly aggravate eczema symptoms, but the triggers are subject to change among individuals.

Hormones

Hormones also play a role in the course of atopic dermatitis, including the stress hormone cortisol which triggers an inflammatory immune response affecting all organs of the body, including the skin.

Mould exposure

Mould exposure and susceptibility to mould can cause Chronic Inflammatory Response Syndrome (CIRS), of which dermatitis is a manifestation.

Functional testing considerations

There are a range of tests that are helpful in identifying the factors that may be contributing to dysregulation of blood glucose, insulin, and inflammation in the body.  Some of these tests include:

A comprehensive cardiovascular profile screens for the most important markers for cardiovascular disease and cardiometabolic disease.  

In some cases it can be helpful to have certain general pathology tests done for things like fasting blood glucose, glucose tolerance, serum insulin levels and HbA1c (a measure of blood glucose levels over the previous 3 months)

Organic Acids test helps to identify if other metabolic pathways have been affected by or are contributing to the development of Type 2 Diabetes Mellitus.

Insulin Resistance Index helps to identify if the blood glucose dysregulation is affected by or contributing to the development of insulin resistance.

Common misconceptions

One of the most common misconceptions about the development of type 2 Diabetes Mellitus is that it is caused by overconsumption of sugar.  

During digestion and metabolism the body breaks down carbohydrates, fats and proteins, all of which contribute to the production of glucose.  In particular refined carbohydrates and saturated fats will contribute to elevated blood glucose levels and are implicated in driving the underlying inflammatory state that will progressively lead to the development of Type 2 Diabetes Mellitus.

Alongside diet, decreased uptake of glucose in the peripheral circulation by the muscles, liver function, kidney function, and whole body glucose utilisation contribute to the development of Type 2 Diabetes Mellitus.

Cerosimo, E., Triplitt, C., Solis-Herrera, C., Mandarino, LJ., & DeFronzo, RA. (2018) Pathogenesis of Type 2 Diabetes Mellitus, [Updated 2018 Feb 27]. In: Feingold, KR., Anawalt, B., Boyce, A., et alitors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279115/

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